Open Access Highly Accessed Debate

Defining mental illnesses: can values and objectivity get along?

Dominic Sisti1*, Michael Young2 and Arthur Caplan3

Author Affiliations

1 Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA

2 Harvard Medical School, Boston, USA

3 Division of Medical Ethics, NYU Langone Medical Center, New York University, New York, USA

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BMC Psychiatry 2013, 13:346  doi:10.1186/1471-244X-13-346

Published: 24 December 2013



The creation of each edition of the Diagnostic and Statistical Manual (DSM) of psychiatry has proven enormously controversial. The current effort to revise the ‘bible’ of disorder definitions for the field of mental health is no exception. The controversy around DSM-5 reached a crescendo with the announcement from National Institute of Mental Health (NIMH) that the institute would focus efforts on the development of their own psychiatric nosology, the Research Domain Criteria (RDoC) (NIMH, 2013).


The RDoC seem to be structured around the concern that the only way to find objectivity in the classification of diseases or disorders in psychiatry is to begin with biology and work back to symptoms. Values infuse medical categories in various ways and drive practical considerations about where and how to divide up constellations of already agreed upon symptoms.


We briefly argue that all nosologies are infused with values and, while we should continue to sharpen the psychiatric nosology, normativity will permeate even the strictest biologically based taxonomy; this need not be a bad thing.